IMS Health, Allschwil, Switzerland.
Diabet Med. 2010 Feb;27(2):189-96. doi: 10.1111/j.1464-5491.2009.02902.x.
Although limited clinical data exist for anti-CD3 monoclonal antibody therapies, it is believed that they may influence glycaemic control, endogenous insulin secretion and hypoglycaemic event rates in individuals newly diagnosed with Type 1 diabetes. In the absence of suitable empirical evidence, the objective of this study was to estimate the potential long-term clinical outcomes associated with treatment via a hypothetical modelling analysis.
Analyses were performed using a published and validated computer simulation model of diabetes in a hypothetical US cohort based on published literature and expert opinion. The efficacy of anti-CD3 monoclonal antibody treatment was estimated from clinical data and expert opinion and simulations were performed over a 60-year time horizon. The impact on quality of life associated with treatment was also captured via published utility values.
Assuming that a treatment course of an anti-CD3 monoclonal antibody produced an initial reduction in glycated haemoglobin of -0.8%, and that the effects persisted for up to 5 years, treatment was projected to lead to an increase in undiscounted life expectancy of 0.43 years and an increase in quality-adjusted life expectancy of 0.36 quality-adjusted life years compared with conventional exogenous insulin.
A course of a hypothetical anti-CD3 monoclonal antibody treatment associated with improved glycaemic control and, potentially, the preservation of pancreatic beta-cell function was estimated to lead to improved life expectancy and quality-adjusted life expectancy compared with conventional treatment in patients with newly diagnosed Type 1 diabetes.
尽管针对抗 CD3 单克隆抗体治疗的临床数据有限,但人们认为它可能会影响新诊断为 1 型糖尿病个体的血糖控制、内源性胰岛素分泌和低血糖事件发生率。由于缺乏合适的经验证据,本研究的目的是通过假设建模分析来估计与治疗相关的潜在长期临床结果。
使用基于文献和专家意见发表的、针对美国假设队列的糖尿病计算机模拟模型进行分析。抗 CD3 单克隆抗体治疗的疗效是根据临床数据和专家意见估计的,模拟时间跨度为 60 年。通过发表的效用值还捕获了与治疗相关的生活质量影响。
假设抗 CD3 单克隆抗体治疗疗程可使糖化血红蛋白初始降低 0.8%,且疗效持续长达 5 年,与常规外源性胰岛素相比,治疗预计将使无折扣预期寿命增加 0.43 年,质量调整预期寿命增加 0.36 个质量调整生命年。
与常规治疗相比,新诊断为 1 型糖尿病的患者接受假设的抗 CD3 单克隆抗体治疗,可改善血糖控制,并可能保留胰岛β细胞功能,预计可改善预期寿命和质量调整预期寿命。